{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WYLEAN JENKINS","gend":1,"add":"1720 CULLEN AVE","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1939-05-24","age":"","mstatus":"","insh":"900039206*01","cliId":"","pno":"757\/226-8885","cno":"","email":"","ename":"","eno":"","pphy":"GUNTHER, ALTHEA O MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5196","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","R82.90","R39.81","L22.","R42.","R20.2","I16.0","R20.0","R11.2","I48.0","E87.6","Z00.00","Z13.31","M81.0","K21.9","M19.90","E66.9","Z91.81","R10.32","M54.5","K57.30","M51.36","I48.91","I10.","Z79.01","Z79.899","Z88.1","Z90.710","R07.9","R19.7","R06.00","I45.10","K57.90","M15.0","H35.54","Z96.1","Z12.31","D50.9","R12.","Z68.41","R53.1","Z23.","Z96.652","M79.89","K59.00","Z71.3","R06.02","R00.0","E66.01","E78.9","Z12.39","R10.13","N28.1","R51.9","M62.838","J30.9","E55.9"],"date":["2020-09-19","2020-05-22","2021-06-28","2021-06-28","2020-09-16","2021-06-16","2020-09-19","2020-09-19","2020-09-19","2021-11-09","2020-10-20","2021-09-07","2021-09-07","2021-09-07","2021-11-09","2020-09-16","2020-09-16","2021-02-23","2020-07-16","2020-07-16","2020-07-17","2020-07-16","2020-07-16","2021-11-09","2020-10-20","2020-09-16","2020-07-16","2020-07-16","2020-09-15","2020-09-15","2020-10-20","2021-11-09","2020-10-20","2020-10-20","2021-03-05","2021-03-05","2021-07-16","2020-08-24","2020-08-24","2020-09-16","2020-09-16","2020-10-09","2020-09-16","2020-10-09","2021-08-17","2020-05-18","2020-09-16","2020-09-16","2021-11-09","2021-11-09","2021-07-16","2020-09-16","2020-09-16","2020-10-06","2020-10-06","2020-12-01","2020-12-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","60505082901","FLUTICASONE PROPIONATE                                                ","50MCG","-48","Select","Select",""],["","00168025846","CLOTRIMAZOLE\/BETAMETHASONE DIPROPIONATE                               ","DIPROP","-135","Select","Select",""],["","68180051902","LISINOPRIL\/HYDROCHLOROTHIAZIDE                                        ","20-12.5","90","Select","Select",""],["","00378003210","METOPROLOL TARTRATE                                                   ","50MG","180","Select","Select",""],["","00003089421","ELIQUIS                                                               ","5MG","180","Select","Select",""],["","68382041205","OMEPRAZOLE                                                            ","20MG","-90","Select","Select",""],["","62332000231","FAMOTIDINE                                                            ","40MG","15","Select","Select",""],["","00456120330","LINZESS                                                               ","72MCG","30","Select","Select",""],["","65862050320","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","875-125","10","Select","Select",""],["","52817033010","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","5MG","20","Select","Select",""],["","68180098202","LISINOPRIL                                                            ","30MG","90","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE                                                   ","5MG","-30","Select","Select",""],["","00536333401","VITAMIN D-1000                                                        ","1000UNIT","90","Select","Select",""],["","00185012201","NITROFURANTOIN MONOHYDRATE                                            ","100MG","10","Select","Select",""],["","80681016900","VITAMIN D3                                                            ","25MCG","90","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE                                              ","COVID-19","0","Select","Select",""],["","40985027531","CALCIUM 600+D3                                                        ","600-800","180","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}